Permit CITY OF TIGARD MASTER PERMIT
C • COMMUNITY DEVELOPMENT Permit#: MST2021-00072
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/23l2021
Parcel: 2S107AA13700
Jurisdiction: Tigard
Site address: 16693 SW SUNSHINE COAST ST
Subdivision: ROSHAK RIDGE Lot: 137
Project: Polygon at Roshak Ridge, Lot 137
Project Description: New detached dwelling
BUILDING
Floor Areas Required Setbacks Required
Stones: 2 Bedrooms: 3 First: 925 sf Basement: 0 sf Left: 3 Parking Spaces: 0
Height: 28 Bathrooms: 3 Second: 1188 sf Garage: 422 sf Front: 8 Smoke
Dwelling Units: 1 Third: 0 sf Right: 3
Detectors: Yes
Total: 2113 sf Value: $279,322.04 Rear: 10
PLUMBING
Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 1 Urinals: 0
Lavatories: 5 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Storm Sewer: 100
Drains: 0
Tubs/Showers: 3 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Catch Basins: 0
Bckflw Prevntr: 0
Footing Drain: 0 Ice Maker: 1 Hose Bib: 2 Backwater Value: 1
Drywall-Trench Drain: 0 Other Fixtures: 0
Other Fixture Units:
MECHANICAL
Fuel Tvpes Air Conditioning: Y Vent Fans: 4 Clothes Dryers: 1
Natural Gas Heat Pump: N Hoods: 1 Other Units: 0
Furn<100K: 1 Vents: 0 Woodstoves: 0 Gas Outlets: 3
Furn>=100K: 0
ELECTRICAL
Residential Unit -Service Feeder Temp SrvclFeeders Branch Circuits
1000 sf or less: 1 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0
Ea add?500 sf: 4 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 0
Mfd Home/Feeder/Svc: 0 401-600 amp: 0 401-600 amp: 0
601-1000 amp: 0 601+amp-1000v: 0
1000+ampNolt: 0
ELECTRICAL-RESTRICTED ENERGY
SF Residential
Audio&Stereo. N HVAC: N Security Alarm N Vaccuum System: N Garage Opener: N All
Other. N Other Description: Ecompasing: Y
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
NEW SF VB R-3 2113
Owner: Contractor:
POLYGON WLH LLC WILLIAM LYON HOMES INC Required Items and Reports(Conditions)
703 BROADWAY ST STE 510 703 BROADWAY STREET,SUITE 510 1 Ersn Cntrl 503-639-4175
VANCOUVER,WA 98660 VANCOUVER,WA 98680 2 One Hour Fire Rated Eaves
PHONE: PHONE: 360-695-7700
FAX:
Total Fees: $40,374.58
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Roily Van,D Wege O iv A}� UcAttIOn
Issued By: Permittee Signature: rp
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the Job site at the time of each inspection.
Building Permit Application g —4) 7 /.,(
Residential � FOR OFFICE USE ONI.1.
��^''�(
City of Tigard 1 i E C E I V(g 0 E
Received
,r2 �C'2 Permit No: p 7
Date/By:��'r/J-WL���� �MJ7H/Zl-�LS7Z
q 13125 SW Hall Blvd.,Tigard,OR 97223 n ^ Plan Review =`
FEU t t a q 24 Other Permit:SW?2oZL-OOO
Phone: 503.718.2439 Fax: 503.598.1960 Date/By:
Inspection Line: 503.639.4175 _. , 3Date Ready/By:
TIGARD CiTY OtI;� AR /�/� i f � Hu pSpelee mPe neta2l Ifonrfo rmationIntrnet: www.tigard-or.gov tifed/Method•
Bfljf C: f,t\ll a .
TYPE OF WORK REQUIRED 'DATA:1-AND 2-FAMILY DWELLING
is New construction ❑Demolition Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
❑Addition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application, f
Valuation: $ ?79/ 322,° 1
® 1-and 2-family dwelling IDCommercial/industrial
ElAccessory building El Multi-familyNumber of bedrooms: 3
❑Master builder ❑Other: Number of bathrooms: >k3
JOB SITE INFORMATION AND LOCATION Total number of floors: 2 2636 p
Job site address:16693 SW Sunshine Coast St New dwelling area: 2113 square feet 18 0
City/State/ZIP:Sherwood,OR 97140 Garage/carport area: a�
422 square feet 92
Suite/bldg./apt.no.: Project name:Polygon at Roshak Ridge Covered porch area: p square feet
Cross street/directions to job site: Deck area: `��� square feet
VA-
eOther structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: Lot no.: 137 Permit fees*are based on the value of the work performed.
Tax map/parcel no.: Indicate the value(rounded to the nearest dollar)of all
equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
New Single Family Valuation: S
Existing building area: square feet
i
New building area: square feet
® PROPERTY OWNER 0TENANT Number of stories:
Name:Polygon Homes WLH LLC Type of construction:
Address:703 Broadway St., Ste 510 Occupancy groups:
City/State/ZIP:Vancouver,WA 98660 Existing:
Phone:( )360 695-7700 Fax:( )360 693-4442 New:
2l APPLICANT ❑ CONTACT PERSON 6:9 BUILDLNG PERMIT FEES*
Business name:Polygon Homes WLH LLC (Please refer to fee schedule
Structural plan review fee(or deposit): 39
Contact name:Omar Alami Abouhafs
FLS plan review fee(if applicable):
Address:703 Broadway St., Ste 510 Total fees due upon application:
City/State/ZIP:Vancouver,WA 98660
Amount received:
Phone:( )360 695-7700 Fax: :( )360 693-4442
E-mail: PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted PhotoVoltaic Solar Panel System.
Business name:Polygon Homes WLH LLC Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address:703 Broadway St., Ste 510 Solar Installation Specialty Code checklist.
Permit Fee(includes plan review
city/State/ZIP:Vancouver, WA 98660 and administrative fees): $180.00
Phone:( )360 695-7700 Fax:( )360 693-4442 State surcharge(12%of permit fee): $21.60
CCB lic.:207247 Total fee due upon application: $201.60
Authorized signature: 0j4LC14..A 7a.cY 456.44 This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name:Omar Alami Abouhafs Date: 02/15/2021 *Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(I I/02/COM/WEB)
Mechanical Permit Application FOR OFFICE USE.ONLY
City of Tigard RECEIVE I Received M� ZD DateBy: PermitNo,: q' 2i-coo 72-
• ! 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
• Phone: 503.7182439 Fax: 503.598.1960 FEB 1 7 2021 Date/By; Other Permia
T I{its It 1 i Inspection Line: 503.639.4175 Date Ready/By: hots:
See
Internet www.tigard-or.gov
CITY OF TIGARD NOlifiedNeththd.
Supplemental Information
BUILDN P(Ur.sON TYPE OF WORK COMMERCIAL FEE* SCHEDULE:— USE CHECKLIST
El New construction El Addition/alteration/replacement Mechanical penult fees*are based on the value of the work
P performed.Indicate the value(rounded to the nearest dollar)of all
0 Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit.
Value:S
CATEGORY.OF CONSTRUCTION RESMENTLV.EQUIPMENT/SYSTEMS FEES*
Iig 1-and 2-family dwelling ❑Commercial/tndustrial ❑Accessory building For special information use checklist
I j Multi-family 0 Master builder 0 Outer. Description Qty. Ea Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning J I 46.75
Job site address: 16693 SW Sunshine Coast St Pomace 100,000 BTU Mourn/cots) 46.75
City/State/ZIP:Tigard,OR 97224 Furnace 100,000+BTU(ducts/vents) 54.91
Suite/bldg./apt.no.: Project name: Polygon at Roshak Ridge Heat pump 61.06
Duct work 23.32
Cross street/directions to job site: Hydronic hot water system 23.32
Residential boiler(radiator or
hydronic) 23.32
Unit heaters(fuel-type,not electric),
in-wall,in-duct,suspended,etc. 46.75
Fluefvent for any of above 23.32
Subdivision: Roshak Ridge I Lot no.: 137 — Other 23.32
Other fuel appliances:
Tax map/parcel no.: Water beater 23.32
DESCRIPTION OF WORK Gas 5replacefrnsert 33.39
Flue vent for water heater or gas
fireplace 23.32
Log lighter(Ras) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
® PROPERTY OWNER Q TENANT
Other: 23.32 I
• Environmental exhaust and ventilation:
Name:Polygon WLH,LLC Range hood/other kitchen
ipmt
Address:703 Broadway St.,Ste.510 a Clothes r 33.39
dryer exhaust 33.39
City/State/ZIP:Vancouver,WA 98660 Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 23.32
Phone:(360)695-7700 Fax:( ) Aric/crawlspace fans 23.32
® APPLICANT ❑ COPTTACT PERSON Other: 23.32
Business name:Polygon WLH,LLC Fuel piping:
$14.15 for Brat four,S4.03 for each additional
Contact name:Tonja Morris Furnace,etc.
Address:703 Broadway St.,Ste 510 Gas heat pump
Wall/suspended/unit beater
City/State/ZIP:Vancouver,WA 98660 Water heater
Phone:(360)695-7700 Fax::(360)693-4442 Fireplace
Range
E-mail:permitsubmittals@tayIOrmorrison.com Barbecue
CONTRACTOR Clothes dryer(,gas)
Business name:Pro Heating&Cooling Other.
MECHANICAL PERMIT FEES*
Address: NW Alociek Dr,Ste.1104
Subtotal
City/State/ZIP:Hillsboro,OR Minimum permit fee(S90.00)
Phone:(360)270-1590 Fax:( ) Plan review(25%of permit fee)
State surcharge(12%of permit fee)
CCB lic.:209001 TOTAL PERMIT FEE
e This permit application expires if a permit is not obtained within 180
Sd: a f:(A,��n_ days after it has been accepted as complete.
Authorized signature: (�W JJ • Fee methodology set by Tri-County Building Industry Service Board
Print name:Elia Duran Date: 10/30/20
r-1Mn.'MinpAPrnnn,\pmf P.,.r.x inn hMt 12 A... sin Ast r.it r•n rrn4rmn-o.
Electrical Permit Application r ! f FOR OFFICE USE ONLY
Received
City of Tigard � A.9 �{ Date/By: Permit# 3: M zy._00072_
_ 13125 SW Hall Blvd.,Tigard,OR 97223 p 4 rs Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 `B .. d 210 Date/By: Related Permit#:
Inspection Line: 503.639.4175 (''. _ Ready DaDate/By: 1uds. I FI See Page 2 for
TIGARD Internet: www.tigard-orgov ` Notified/Method: Supplemental Information
TYPE OF WOII'!4'
r,....221l1', ' _ PLAN REVIEW
®New construction ❑Addition/alteration/replacement Please check all that apply(submit 2 sets of plans iv'items checked):
O Service or feeder 400 amps or more 0 Building over three stories.
❑Demolition ❑Other: where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
® 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
CI Multi-family ❑Master builder ❑Other: 0 Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
❑Addition of new motor load of system.
Job#: Job site address: 16693 SW Sunshine Coast tootsPormore. ❑"A","E","h-z","1-3",
City/State/ZIP: Tigard OR 97224 ❑Six or more residential units. 0 Recreational vehicle
❑Health-care facilities. parks.
Suite/bldg./apt.#: Project name: Polygon at Roshak Ridge ❑Hazardous locations 0 Supply voltage for more than
O Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: FEE SCHEDULE
Description I Qty. I Each I Total I "
New residential single-or multi-family dwelling unit.
Subdivision: Roshak Ridge Lot#:137 Includes attached garage.
1,000 sq.P.or less 168.54 4
Tax map/parcel#:
Ea.add'l 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
(with above sq.11) 75.00 2
Limited energy,multi-family 75.00 2
residential(with above sq.tt)
Renewable Energy 0 See Page 2
fa PROPERTY OWNER ❑ TENANT Services or feeders installation,alteration,and/or relocation
Name: Polygon Homes WLH, LLC 200 amps or less 100.70 2
Address: 703 Broadway St., Ste 510 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP: Vancouver,WA 98660 601 amps to 1,000 amps 301.04 2
Phone:(360 )695-7700 Fax:( ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email:permitsubmittals@taylormorrison.com relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 1
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature: __ Date: 401 amps to 599 amps 168.54 2
El APPLICANT J ❑ CONTACT PERSON
Branch circuits—new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: Polygon Homes WLH, LLC above service or feeder fee, 7.42 2
each branch circuit
Contact name: Omar Alami Abouhafs B.Fee for branch circuits without
service Address: 703 Broadway St., Ste 510 branch i feeder fee,firstr 56.18 2
City/State/ZIP: Vancouver WA 98660 Each add'l branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:(360 )816-7800 Fax: : ( ) Each manufactured or modular 67.84 2
Email: permitsubmittals@taylormorrison.com dwelling,service and/or feeder
Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: Portland Electric Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy 0 See Page 2 2
Address: 1915 E 5th St., Ste D panel,alteration,or extension.
Each additional inspection over allowable in any of the above
City/State/ZIP: Vancouver,WA 98661
Additional inspection(1 hr min) 6625/hr
Phone:( 360)314-4915 Fax:( ) Investigation(1 hr min) 90.00/hr
Email:paul@portlandelectric.biz Industrial plant(lhrmin) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lic.: 194066 Electrical Lic.: C760 Suprv.Lic.: 4920E IS' specifically listed([%hrmin)
n e_ 0 - _ ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: l�l,C.f.�+ Subtotal:
Print name: Alex Shalya Da e:10/30/20 ❑Plan Review Required(25%of permit fee):
s,�0 �'�/� - - o� -� p L State surcharge(12%of permit fee):
Authorized signature: �v I l l.(-d�ild'JfLl.LI�L TOTAL PERMIT FEE:
D U This permit application expires if a permit is not obtained within 180
Print name: Sergey Mishchuk Date:10/30/20 days after it has been accepted as complete.
* Number of inspections allowed per permit.
I:1Bullding1Pemits1ELC_PemtitApp_ELR_ERE_doc Rev 06/17/2015 440-4615Tt11/05/COM/WEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
Fee for all residential systems combined: $75.00 ne9Cew°" I Qtr. I Each Total
y Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 00.70 2
5.01 to 15 kva 133.56 2
El Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
•
Wind generation systems in excess of 25 kva:
❑ Burglar Alarm 25.01 to 50 kva 301.04 2
❑ Gara e Door O ener* 50.01 to 100 kva 552.26 2
g p >100 kva(fee in accordance
with OAR 918-309-0040) 552.26 2
El Heating,Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System* Each additional kva over 25 7.42 3
❑ Vacuum Systems* >100 ha—no additional charge 0.0 3
Each additional inspection over allowable in any of the above:
El Other: Each additional inspection is (ib 251 hr 1
charged at an hourly(1 hr min) •
Inspections for which no fee is 90.00;to
specifically listed('4 hr min)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Fee for each commercial system: $75.00 Subtotal(Enter on Page 1):
y * Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
I I Boiler Controls
Clock Systems
El Data Telecommunication Installation
El Fire Alarm Installation
El HVAC
El Instrumentation
El Intercom and Paging Systems
El Landscape Irrigation Control*
El Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other:
Total number of commercial systems: _
*No licenses are required. Licenses are required for all
other installations
I.1Buildin lPemits\ELC Permi1App ELR ERE.doc Rev 06/17/2015
Plumbing Permit Application Building Fixtures RECEIVE"- FOR OFFICE USE ONLY
Iii City of Tigard t 7 Rceterted Permit No M,g
t 13125 SW Hall Blvd.,Tigard,OR 97223 E� 14 2021 Plate sy. T102 ..Cho�Z
Phone: 503.7182439 Fax: 503.598.19 DePlan1efgy.eW Other Permit No.:
Inspection Line: 503.639.4175 �+I��r f1�A D toReady/By. Attic 0SeePage2for
TlcnRn Internet: wwv tigard-or.gov BUILDING M!VASIO\wrotinm1 .eth xl: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
E4 New construction 0 Demolition For special information use checklist.
Description I Qty. I Ea. 1 Total
❑Addition/alteration/replacement 0 Other: New I-2-family dwellings(includes 100 ft.for eacb utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
XI-and 2-family dwelling 0 Commerciallindustrial SFR(2)bath 437.78
buildingSFR(3)bath 500.32
❑Accessory VI-Multi-family
Each additional bath/kitchen 25.02
❑Master builder ❑Other: Fire sprinkler(-s9ft.) Page2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 16693 SW Sunshine Coast St Catch basin or area drain 18.76
City/State/ZIP:Tigard,OR 97224 Drrivell,leach line,or trench drain 18.76
Footing drain(no.linear ft:_) Page 2
Suite/bldg./apt.no.: I Project name:dHaserbeigiiskirePolygon at Roshak Ridge Manufactured home utilities $0.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.:_) Page 2
Storm sewer(no.linear ft.:_) Page 2
Water service(no.linear ft.: ) Page 2
Subdivision:Roshak Ridge I Lot no.: 137 Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
�_ PROPERTY OWNER I 0 TENANT Expansion tank 12.51
Name:Polygon WLH,LLC Fixmre/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:703 Broadway St.,Ste 510
Garbage disposal 25.02
City/State/ZIP:Vancouver,WA 98660 Hose bib 25.02
Phone:(360)695-7700 Fax:( ) Ice maker 12.51
® APPLICANT 0 CONTACT PERSON Interceptor/greasetrap 25.02
Business name:Polygon WLH,LLC Medical gas(value:$_) Page 2
Primer 12.51
Contact name:Tonja Morris
Roof drain(commercial) 12.51
Address:703 Broadway St.,Ste 510 Sink basin/lavatory 25.02
City/State/ZIP:Vancouver,WA 98660 Solar units(potable water) 62.54
Phone:(360)695-7700 Fax::(360)693-4442 Tub/shower/shower pan 12.51
E-mail:permitsubmittals(apolygonhomes.com Urinal 25.02
CONTRACTOR Water closet 25.02
Water heater 37.52
Business name:G&B Plumbing&Sons Inc Water P tPin8/D WV 56.29
Address:P.O.Box 92 Other. 25.02
City/State/ZIP:St.Paul,OR 97137 Subtotal
Phone:(503)868-1417 Fax:(971)727-8170 Minimum permit fee: S72.50
CCB Lie.:184372 Plumbing Lic.no.:pb634 Plan review (25%of permit fee)
- State surcharge(12%of permit fee)
Authorized signature: y{, TOTAL PERMIT FEE
Print name:Steve Fowler Date: 10/30/20 This permit application expires if a permit Is not obtained within 180 days
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board
l::tOuadinatPerminuPLMU-PecmltAppdoe 10r'OIA09 4404616T(1041,COMRVEB)
City of Tigard 2/17
_IN COMMUNITY DEVELOPMENT DEPARTMENT
Building Permit Review — Residential
TIGARD
Building Permit #: ST 20 Z/- 00072L
Site Address: 16693 SW Sunshine Coast St
Project Name: Polygon @ Roshack Ridge Lot #: 137
Planning Review
Proposal: new house
® Verify address/suite# active in Accela. ® In River Terrace: ❑ No ❑ Yes, River Terrace Review Addendum
Site Plan Elements: ®Erosion Control
[ 3 copies of site plan on 8-1/2"x 11" or 11 x 17"paper Ila Retained trees with drip line and tree protection measures
®Drawn to scale (standard architect or engineer scale) XFootprint of new structure(including decks)and FFE
[XNorth arrow XUtility locations&easements(required for new and additions)
ICSite address,project or subdivision name and lot number ®Sidewalk/driveway approach
[XApplicant information(name and phone number) na Location of wells/septic systems
®Lot dimensions and building setback dimensions XStreet tree size,type and location
na Square footage of buildings to be demolished ®Street names
naflExisting structures on site CCorner elevations(2'contours if more than 4'differential)
XLot area,building coverage area,percentage of coverage and >1,000 sf of impervious area created or replaced? Ej3J ENo
impervious area(applicable if R-7,R-12,R-25&R-40) If yes,is a storm water quality facility shown? ❑Yes ❑No
® Clean Water Services—Service Provider Letter(lot platted prior to 9/10/1995):
Required: ❑ Yes,applicant was notified ® No Received: ❑ Yes ❑ No
® Water Meter Fixture Unit Worksheet—Additions,Remodels and ADUs
Required: ❑ Yes,applicant was notified X No / 0Received: E Yes ❑ No
® SDC Exemption for ADU applied for: ❑ Yes \f No fr Received: ❑ Yes ❑ No
® Public Fadlttig Improvement (PFI) Permit:
Required: V Yes,applicant was notified No Applied For: /Yes ❑ No,stop intake
® Land Use Case#: PDR2015-00002 ® Zoning: R-12
® Required Setbacks: Front: 8 Rear: 10 Side: 3 Street Side: na Garage: 20
® Building Height: Max.Height: na Actual Height: 28
® Landscape Area: 20 % ® Lot Coverage Max: 80
Entrance t back no more than 8' from street-facing wall ❑ Parallel to street or offset 45 s or less
Windows ❑ Minimum a of all street-facing facades
Garage ❑ Garage door is behind widest • wall ❑ Ye o,one of the following is met:
El Door extends no more than 5' from wa a • a covered porch extending beyond garage.
❑ Door extends no more than 5' f a and there is a t.window above garage on 2°d floor.
❑ Garage door width is or less El 50%or less of facade ° or less and includes 7 of following:
El Covered t El Recessed entrance ❑ Wall offset ❑ 1'Roof ea ❑ Roof offset
❑ F. ingles ❑ Lap Siding ❑ Roof pitch ❑ Gable,hip,or gambrel roo Dormer
Accent siding ❑ Window trim ❑ Window recess El Window projection cony
® Visual Clearance ® Urban Forestry Plan
gl Sensitive Lands: 0 Yes ® No '1' e:
® Conditions met prior to issuance of building permit[Approved By Planning: — � Date: /
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved 0 Not Approved
Revision 2: 0 Approved ❑ Not Approved
ClBuildinglForms\BldgPemiitRvw_RES_I22419.docx
Building Permit Submittal
Original Submittal Date: 6&2-/7-242I
Site Plans: #
Building Plans: # 3
Building Permit#: L�Enter building permit#above. ��
Workflow Routing: LS 'Planning [ Engineering C�Permit Coordinator LK Building
Workflow Sign-off: L'Sign-off for Planning(include notes from planning review)
Route Application Documents: Engineering: (1) copy of permit application, (1) site plan, (1) building plan and
original plan review routing form.
Building: original permit application, site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes:
By Permit Technician: Date: '03-G3-.2ozi
Engineering Review
dir Slope at building pad: 21
L�Conditions "Met"prior to issuance of building permit
Easements (encroachments) per engineering conditions of approval and plat
ra/Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: ❑ Yes LNo
Assess Water Quantity Fee in-lieu: ❑ Yes Ar,� No
LIDA Facility on lot ❑ Yes Ef/No
Final Plat Recorded:
❑ NOT Approved by Engineering: Date:
Notes:
Approved by Engineering: Date: 3
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Permit Coordinator Review
Conditions"Met"prior to issuance of building permit
❑ Approved, NOT Released: Date:
Notes:
Revisions (after Building Submittal only)
Revision Notice 1: Date Sent to Applicant:
Revision Notice 2: Date Sent to Applicant:
SDC Exemption: ❑ Received Does not apply
XSDC Fees Entered: Wash Co Trans Dev Tax: ,71 yes ❑ N/A
Tigard Trans SDC: Yes ❑ N/A
Parks SDC: Zr Yes ❑ N/A
LIDA ❑ Yes `i N/A
X OK to Issue Permit
Approved by Permit Coordinator: tr4
Date: $1S I/102./1
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1
City of Tigard
COMMUNITY DEVELOPMENT DEPARTMENT
i III ■
T I G A RD River Terrace Building Permit Review Addendum
Building Permit #: /-1 sr2ozr 000 72
Site Address: 16693 SW Sunshine Coast St
Project Name: Polygon @ Roshack Ridge Lot #: 137
(New dwelling=subdivision name;Addition or Alteration=last name of owner)
P1aPilir o Review ofl?iver Terrace P1arl.District Desikti Standards (18.640.070.I.):
Is the project subject to the plan district design standards? El Yes ❑ No
1.Articulation: a minimum of 1 element per each street-facing facade that has 30-60 ft. of frontage..An additional
element required for lots with over 60 ft. of street frontage shall be provided every 30 ft.
Balcony w/ access 2 Window Projection Vertical Wall Offset a
Porch min. 5 ft. deep ft. deep min. 2ft., 5 ft.wide min. 2 ft., 6ft. wide Gabled dormer
g ❑ ❑ ❑ ❑
2. Eyes on the street: a minimum
12%f each street facing facade must include windows or entrance doors.
Percentage Shown: ,2 ° o
3. Entrances:At least one entrance must meet both of the following standards:
IX Max. 8 ft. setback from longest street- facing wall ® Parallel to street, angle no more than 45° from street,
or open onto porch
Entrance opens to a porch: ®Yes ❑ No
If yes,all the following apply: ® 25 sq.ft. min.
® One street facing entry 12 ft max.roof above floor of porch
® 5 ft. depth min. k1 30% min.porch roof coverage
4. Detailed Design: All buildings shall include a min. of five of the following elements on all street-facing facades:
] Covered porch min. 5 ft.wide x 5 ft. deep C$Recessed entry area min. 5 ft.wide x 2 ft. deep
® Wall offset min. 16 inches ❑ Dormer min. 4 ft.wide
1 Roof eave min. 12 inch projection ® Roof offset min. of 2 ft.
D Roof shingles either tile or wood g Gable, hip or gambrel roof design
❑ Roof pitch oriented south min. 500 sq. ft. ❑ Horizontal lap siding min. 3-7 inches wide
❑ Accent siding min. 40%of street facade X Window trim min. 2'/2"wide by 5/8" deep
❑ Window recess min. 3 inches for all street facing ❑ Bay window min. 5 ft.wide by 2 ft. deep
O Balcony min. 5 ft.wide x 3 ft. deep with inside access 0 Attached garage is 35% or less of street facade
5. Garages and Carports: May face the front or side lot line on a corner lot.
Setbacks:
No closer to front or side lot line, than longest street-facing wall. ® Yes 0 No. If No (Check one):
❑ May extend up to 5 ft.if there is a covered front porch and garage does not extend beyond the front porch.
❑ May extend up to 5 ft.where the garage is part of a two-story building and there is a window at the second story
above the garage that faces the street with a min. area of 12 sq.ft.
Width: (Check one)
❑ 12-foot-wide garage door ❑ 40%max. of street facade
® 50%max. of street facade with 7 detailed design elements
Notes:
Approved By Planning: — Date: i 2
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